| Thomas Wilson Psychotherapy, Llc | |
|
4700 Millenia Blvd Ste 500 Orlando FL 32839-6019 | |
| (970) 930-1264 | |
| (970) 431-2327 |
| Full Name | Thomas Wilson Psychotherapy, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 4700 Millenia Blvd Ste 500, Orlando, Florida |
| Authorized Official Name and Position | Thomas Warren Wilson (OWNER) |
| Authorized Official Contact | 9709301264 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Thomas Wilson Psychotherapy, Llc 4700 Millenia Blvd Ste 500 Orlando FL 32839-6019 Ph: (970) 930-1264 | Thomas Wilson Psychotherapy, Llc 4700 Millenia Blvd Ste 500 Orlando FL 32839-6019 Ph: (970) 930-1264 |
| NPI Number | 1003402892 |
|---|---|
| Provider Enumeration Date | 12/15/2020 |
| Last Update Date | 08/11/2023 |
| Certification Date | 08/11/2023 |
| Medicare PECOS PAC ID | 8527470335 |
|---|---|
| Medicare Enrollment ID | O20201221001530 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003402892 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Thomas Wilson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992218374 PECOS PAC ID: 9830443803 Enrollment ID: I20181109000600 |
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